A positive relationship between receipt of the first dose of hepatitis B vaccine at birth and overall vaccination schedule adherence in the United States has been demonstrated via the results of an analysis published in the American Journal of Preventive Medicine.

The Advisory Committee on Immunization Practices has recommended that the first dose of hepatitis B vaccine be administered at birth since 2005; however, data from a 2016 study showed that roughly 70% of infants in the United States received this vaccination within 3 days of birth. The hepatitis B vaccine is first on the recommended immunization schedule, which includes the administration of 8 other vaccine series between ages 2 and 12 months, but few studies have examined whether children who miss the birth dose are at an increased risk for subsequent vaccination delays.

Therefore, researchers investigated the birth dose as a determinant of up-to-date immunization status at age 18 months, using cross-sectional data collected in 2017 by the National Immunization Survey-Child, and considered the 7 core childhood vaccine series: diphtheria, tetanus, and acellular pertussis; polio; measles, mumps, and rubella; Haemophilus influenzae type B; varicella; hepatitis B; and pneumococcal conjugate vaccine.

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The results found that 11,268 children received the hepatitis B birth dose vaccine, whereas 3775 did not; this represented roughly 75% and 25% of the population, respectively. Further, children who received the hepatitis B birth dose had a 2.01-fold increase in the odds of being up to date on the combined 7-vaccine series compared with children who did not. However, a concern of this analysis was that the relationship between certain variables and birth dose may be nonlinear or modified by other characteristics. Parent attitudes toward vaccination, in particular, are concerning because of their ability to affect vaccination delay and receipt of the birth dose. Interpretation of these study results should also consider potential bias from selection and misclassification.

The study authors concluded that, “Receiving the birth dose is positively associated with up-to-date status later in childhood, highlighting the importance of starting vaccination early.” Future studies should examine the effect of vaccine hesitancy in the relationship between birth dose and up-to-date status.


Vader DT, Lee BK, Evans AA. Hepatitis B birth dose effects on childhood immunization in the U.S. Am J Prev Med. 2020;58(2):208-215.